4 5 Introduction Influenza, commonly known as the flu, is an infectious disease caused by RNA (ribonucleic acid) virus from the Orthomyxoviridae family of influenza viruses that affects birds, animals and humans. The name influenza comes from the Italian influenza, meaning "influence and Latin s influentia. The influenza virus is transmitted through the air by coughs or sneezes, creating aerosols containing the virus. Influenza can also be transmitted by bird droppings, saliva, nasal secretions, feces and blood. Infection can also occur through contact with bodily fluids or through contact with contaminated surfaces. Airborne aerosols have been thought to cause most infections. Influenza viruses can be inactivated by sunlight, disinfectants and detergents. Since the virus can be inactivated by soap, frequent hand washing reduces the risk of infection. Influenza occurs annually around the world in seasonal epidemics killing thousands of people. Millions of people are killed when it is a pandemic. Three influenza pandemics occurred in the 20th century and killed tens of millions of people, with each of these pandemics being caused by the appearance of a new strain of the virus in humans. Often, these new strains appear when an existing flu virus spreads to humans from other animal species, or when an existing human strain picks up new genes from a virus that usually infects birds or pigs. An avian strain named H5N1 raised the concern of a new influenza pandemic, after it emerged in Asia in the 1990s, but it has not evolved to a form that spreads easily between people. Definition of the 2009 H1N1 Swine Flu What is Swine Influenza? Swine flu is a respiratory disease of pigs caused by type A influenza virus that regularly causes 5

5 6 outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian, human as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can swap genes and create new viruses that are a mix of swine, human and/or avian influenza viruses. In April 2009 a new flu strain evolved that combined genes from human, pig, and bird flu, initially dubbed "swine flu" and also known as influenza A (H1N1). It emerged in Mexico, the United States, and several other nations. The 2009 H1N1 virus is referred to as the swine flu because itt contains a unique mix of genetic material from pig, bird and human viruses. Llaboratory test has showed that many of the genes in this new virus were similar to influenza H1N2 viruses that normally occur in pigs (swine) in North America. However, test also revealed that H1N1 has two genes from flu viruses that normally circulate in pigs in Europe and Asia. It also has bird (avian) and human genes. No one has determined how and when these viruses were mixed together. The World Health Organization officially declared the outbreak to be a "pandemic" on June 11, The WHO's declaration of a pandemic level 6 was an indication of its spread, not the severity of the H1N1. What are the signs and symptoms of this virus in people? The symptoms of 2009 H1N1 flu virus in people includes: Fever, 6

6 7 Chills Cough, Headache, Muscle Pains Runny or stuffy nose, Sore throat Body aches, Fatigue. General discomfort Nausea and vomiting Diarrhea. The above symptoms are just a tip of the iceberg. Depending on your state of health, some people infected with the flu may experience respiratory symptoms without a fever. Medical complications caused by the virus can lead to serious sickness. Some people have died as a result of the flu infection H1N1 Flu in Humans The CDC s (Center for Disease Control) questions and answers Are there human infections with 2009 H1N1 virus in the U.S.? Yes. Human infections with the new H1N1 virus are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment. CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new 7

7 8 H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called Flu View. Is 2009 H1N1 virus contagious? CDC has determined that 2009 H1N1 virus is contagious and is spreading from human to human. How does 2009 H1N1 virus spread? Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something such as a surface or object with flu viruses on it and then touching their mouth or nose. What are the signs and symptoms of this virus in people? The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and death has occurred as a result of illness associated with this virus. How severe is illness associated with 2009 H1N1 flu virus? Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred. In seasonal flu, certain people are at high risk of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized 8

8 9 as placing people at high risk of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, and asthma and kidney disease. One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody. How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates? With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65. When the 2009 H1N1 outbreak was first detected in mid-april 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from 9

9 10 this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy. How long can an infected person spread this virus to others? People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus. 10

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The information contained within this document was compiled from sources that include the Center for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, and the Oregon Department

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